tbuckley/cabot-search huggingface dataset:
Abstract 33: Using the AHA's Life Essential 8 Criteria to Assess Sleep Duration and Its Association With Social Determinants of Health in U.S. Children
Authors: Minkyoung Song, Nathan F Dieckmann, Carol M Musil, Laura L Hayman
Journal: Circulation (2023)

Introduction: In 2010, the American Heart Association (AHA) began using 7 indicators to measure cardiovascular health, known collectively as Life’s Simple 7. In June 2022, the AHA added an 8 th indicator: sleep duration. Although earlier studies have examined whether/how the indicators in Life’s Simple 7 might be impacted by social determinants of health (SDoH), few epidemiological studies have examined how SDoH influence the 8 th indicator in U.S. children. Purpose: We used the AHA Life Essential 8 scoring criteria to assess sleep duration among U.S. children and whether certain SDoH were associated with sleep duration. Methods: We utilized data from the 2019-2020 National Survey of Children’s Health. For all children, we calculated the score for sleep duration (range 0 [lowest] to 100 [highest]). Based on the AHA scoring algorithm and the distribution of sleep duration, participants were divided into three mutually exclusive subgroups: (1) those who met age-appropriate optimal sleep duration; (2) those who had 1-&lt;2 hour below or ≥ 1 hour above optimal sleep duration; and (3) those who had ≥ 2 hours below optimal sleep duration. Multinomial logistic regressions were used to assess the association of sleep duration with 4 SDoH factors (adverse childhood experiences [ACEs], received preventive care during past 12 months, food insufficiency, and living in unsafe neighborhoods). We controlled for child’s sex, age, race/ethnicity, and household poverty level. Results: Among children aged 6 to 17 years (n=49,821), the mean sleep duration score was 77.1 (95% CI 76.4 to 77.7) and 65.5% of the children had age-appropriate optimal sleep scores. Three SDoH factors were associated with higher likelihood of suboptimal sleep duration. Adjusting for covariates, for each point increase in number of ACEs the likelihood of having suboptimal sleep duration was increased (relative risk ratios [RR]:1.05 [95% CI 1.02 to 1.09]; 1.21 [95% CI 1.15 to 1.27]). The likelihood of having suboptimal sleep duration was also increased for those who reported food insufficiency at home (RR:1.19 [95% CI 1.06 to 1.33]; 1.67 [95% CI 1.40 to 1.98]) as well as for those who reported living in an unsafe neighborhood (RR: 1.34 [95% CI 1.04 to 1.71]; 1.63 [95% CI 1.19 to 2.23]). Conclusions: Our findings show that using the AHA’s Life Essential 8 scoring criteria, one third of U.S. children do not meet optimal sleep duration standards. These findings highlight the need for greater attention to social and systemic influences on children's sleep health. It is critical for healthcare providers to recognize that suboptimal sleep duration is a risk factor for poor cardiovascular health, and that certain SDoH are associated with suboptimal sleep duration.
Abstract P109: Access to Mental Health Care Services as a Risk Factor for Cardiovascular and Cerebrovascular Disease Mortality
Authors: Nwakaego A Nmezi, Ruth-Alma Turkson-Ocran, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Introduction: Poor access to mental health care is a national epidemic. Individuals with unmet mental health care needs are at increased risk for poor CVH outcomes. Research examining the relationship between mental health care access and CVD/CVA mortality is scarce. Hypothesis and Research Question: We hypothesized that lack of mental health care access would be associated with increased CVD and CVA mortality. Additionally, we examined whether the relationship between mental health care access and CVD/CVA mortality differed by race and ethnicity. Methods: We analyzed data from the National Health Interview Surveys (NHIS) from the years 1999-2018. NHIS data were linked to mortality data from the National Death Index records up to 2018. The main predictor variable was access to mental healthcare services. The primary outcome was mortality due to CVD/CVA. Cox proportional hazards models were performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between mental healthcare access and mortality. The model was adjusted for known confounders. Models were stratified by race and ethnicity. Results: A total of 1,824,334 individuals were included in the study. Participants mean age was (±SD) 43.2 (±.17). Nearly 23% of individuals reported an inability to afford needed mental healthcare services. Mortality due to CVD/CVA was higher among individuals who were unable to afford needed mental healthcare services, however this association was only significant for NH Black (aHR: 1.39 [95% CI 1.05-1.84]) and White adults (aHR: 1.53 [95% CI 1.30-1.81]). Mortality from CVD/CVA due to lack of access to mental health services differed by race and ethnicity. After adjustment, mortality due to CVD or CVA was highest among NH White persons and lowest among NH Black persons. Conclusion: We observed higher CVD/CVA mortality rates among individuals who were unable to afford needed mental healthcare services and their counterparts who obtained needed services. These results differed by race and ethnicity.
Abstract P108: Post-Diagnosis Body Weight Change and Cardiovascular Outcomes in Cancer Survivors
Authors: Hyeok-Hee Lee, Hokyou Lee, Ga Bin Lee, Dong Wook Shin, Danbee Kang, Jong-Chan Youn, Juhee Cho, Hyeon Chang Kim
Journal: Circulation (2023)

Background: The development of cancer and its treatment often entail changes in body weight. This study aimed to investigate the association of post-diagnosis body weight change with cardiovascular disease (CVD) risk in cancer survivors. Methods: From the Korean National Health Insurance database, we identified 112,565 3-year cancer survivors who had been diagnosed with cancer at age ≥20 years from 2006 through 2013 and had normal body weight (body mass index [BMI] 18.5-22.9 kg/m2) before a cancer diagnosis. In categorical analysis, participants were classified into 4 groups according to their post-diagnosis BMI: 1) obesity (BMI ≥25 kg/m2); 2) overweight (BMI 23-24.9 kg/m2); 3) normal weight (BMI 18.5-22.9 kg/m2); and 4) underweight (BMI &lt;18.5 kg/m2). In continuous analysis, post-diagnosis change in BMI was assessed by subtracting pre-diagnosis BMI from post-diagnosis BMI. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or cardiovascular death. We examined the association of post-diagnosis BMI change with CVD risk using cause-specific Cox model. Results: Over a median follow-up of 5.5 years, 3,797 new CVD events occurred. The cumulative incidence of CVD according to post-diagnosis BMI was the highest in the obesity group, followed by underweight, overweight, and normal weight groups (Figure A). The findings remained broadly consistent after multivariable adjustment; being obese post-diagnosis was associated with a higher CVD risk than maintaining normal weight (HR 1.28, 95% CI 1.05-1.58). However, being underweight post-diagnosis was no more associated with the risk of CVD (HR 0.99, 95% CI 0.86-1.14) (Figure B). Similar findings were observed in a continuous analysis (Figure C). Conclusions: Weight gain after a cancer diagnosis was associated with a higher CVD risk, whereas the association was null for post-diagnosis weight loss. CVD prevention programs for cancer survivors should consider incorporating strategies for preventing weight gain.
Abstract MP67: The Relationship of Cardiorespiratory Fitness, Physical Activity, and Coronary Artery Calcification to Incident Cardiovascular Disease Events in Cardia Participants
Authors: Yariv Gerber, Kelley Pettee Gabriel, David R Jacobs, Jennifer Y. Liu, Jamal S Rana, Barbara Sternfeld, J. Jeffrey Carr, Paul D. Thompson, Stephen Sidney
Journal: Circulation (2023)

Introduction: Coronary artery calcification (CAC) score, physical activity (PA), and cardiorespiratory fitness (CRF) are all associated with cardiovascular disease (CVD) risk. While a U-shaped relationship between PA and CRF with CAC has been reported, CAC presence among highly fit individuals was suggested to be benign. Objective: To determine interactive associations of PA/CRF and CAC with outcomes in a cohort of middle-aged adults and to evaluate the relationship of PA/CRF with CAC incidence. Methods: CARDIA participants with CT-assessed CAC at year 20 (2005-06) were included (n=3141, mean age 45y, 57% female, 45% Black). Moderate to vigorous intensity PA (MVPA) was assessed by self-report and accelerometer. CRF was estimated with a treadmill test. Incident CVD events were adjudicated, and mortality data were obtained through 2019. CAC was reassessed at year 25 (2010-11). Cox models assessed hazard ratios (HRs) for CVD and mortality in groups defined by CAC and MVPA/CRF. Logistic models assessed associations with CAC incidence. Results: At baseline, more favorable CVD risk was found among participants with higher MVPA, higher CRF (&gt; median sex-specific duration), and absence of CAC. During a mean follow-up of 13 years, 166 CVD events and 171 deaths occurred. After multivariable adjustment, compared with no CAC and higher CRF (ref), the HRs (95% CIs) for CVD were 5.04 (2.49-10.20) for CAC and higher CRF, 2.26 (1.24-4.12) for no CAC and lower CRF, and 4.27 (2.24-8.14) for CAC and lower CRF (Figure, left panel). The respective HRs for mortality were 1.12 (0.45-2.77), 1.54 (0.91-2.60), and 3.23 (1.82-5.72) (Figure, right panel). Similar findings were observed with self-reported or accelerometer MVPA replacing CRF. Higher CRF and accelerometer MVPA were dose-responsively associated with a lower probability of developing CAC in a 5-year follow-up (P &lt; .01). Conclusions: PA and CRF were inversely associated with CAC incidence in middle-aged adults. CAC presence eliminated the cardiovascular risk advantage of high PA or high CRF.
Abstract MP65: Magnesium-Rich Diet Score is Inversely Associated With Incident Cardiovascular Disease: The Atherosclerosis in Communities (ARIC) Study
Authors: Katherine L Copp, Lyn M Steffen, Casey M Rebholz, Pamela L Lutsey, So-Yun Y Yi, Mary R Rooney
Journal: Circulation (2023)

Background: Numerous studies have shown inverse associations between serum magnesium (Mg) levels and risk of cardiovascular disease (CVD), but studies of dietary Mg have not been consistent. Aim: The association of a Mg-rich diet score with risks of incident CVD, coronary heart disease (CHD), and ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) study was examined. Methods: There were 15,022 Black and White adults without prevalent CVD included in this analysis. Diet was assessed at two visits using an interviewer-administered 66-item food frequency questionnaire. A Mg-rich diet score was created including whole grain products, nuts, fruits, vegetables, legumes, coffee, and tea. Cox proportional hazard regression evaluated the associations of incident CVD, CHD and stroke through 2019 across quintiles of Mg-rich diet score adjusted for demographic characteristics, lifestyle factors, and clinical characteristics. Results: Participants in the highest quintile of Mg-rich diet score compared to the lowest quintile consumed more servings of Mg-rich foods and fiber and less refined grains, red and processed meat, total fat and saturated fat. Over 30 years of follow up, a Mg-rich diet score was inversely associated with incident CVD (HR Q5 vs Q1 =0.88, 95% CI 0.78-0.99, p trend =0.03) and CHD (HR=0.83, 95% CI 0.72-0.96, p trend =0.01); however the diet-stroke association was null (HR=1.08, 95% CI 1.07-1.09, p trend =0.93) (Table). Conclusions: Consuming a diet rich in whole grains, nuts, fruits and vegetables, legumes, coffee and tea is consistent with a lower long-term risk of CVD and CHD.
Abstract P585: Impact of Thrombocytopenia on the Outcomes of Patients Admitted With Heart Failure: Analysis of the National Inpatient Sample
Authors: Sadichhya Karki, Vaishali Deenadayalan, Ramtej Atluri, Raquel Soon-Shiong
Journal: Circulation (2023)

Background: Thrombocytopenia is known to be a marker of adverse clinical outcomes in acute coronary syndromes, pulmonary hypertension and critically ill patients. Its impact on heart failure (HF) patients has not been well characterized. We aim to compare the clinical outcomes in patients admitted for HF with and without thrombocytopenia. Methods: A retrospective cohort study was designed using data obtained from the 2016-2019 National Inpatient Sample (NIS) database. Adult patients (age &gt;18) with a principal diagnosis of Heart Failure (HF) were identified using the International Classification of Diseases code, tenth revision (ICD-10), and were divided into two cohorts based on a secondary diagnosis of Thrombocytopenia. Primary outcomes evaluated were in-patient mortality, Length Of Stay (LOS) and Total Hospitalization Charges(THC). Secondary outcomes included a blood transfusion, AKI, Pneumonia, Sepsis and GI bleed. Results: Out of 1,276,429 adult patients admitted with HF, 70,755 (5.5%) were found to have a diagnosis of thrombocytopenia. The mean age was 72 years for the thrombocytopenia group vs 71 years for the other group. On a multivariate regression analysis after adjusting for confounders, HF patients with thrombocytopenia had double the odds of inpatient mortality (aOR 2.0 , 95% CI 1.84-52.16, p&lt;0.01) and LOS (aOR 2.38 , 95% CI 2.19-2.58 p&lt;0.01) compared to the other group .THC was also increased by 43,376$ ( 95%CI 38,842-47,910 ,p&lt;0.01). Among the secondary outcomes, the rate of blood transfusion (6.4% vs 2.1%, aOR 2.19, 95% CI 2.02-2.38, p&lt;0.01), AKI (37.4% vs 25.0%, aOR 1.5, 95% CI 1.44-1.56, p&lt;0.01), Pneumonia (16% vs 13%, aOR 1.18, 95% CI 1.12-1.25, p&lt;0.01),Sepsis (3.08% vs 1.13, aOR 2.5 ,95% CI 2.22-2.78, p&lt;0.01) and GI Bleed (0.9 %vs 0.4 %, aOR 1.68, 95% CI 1.38-2.05, p&lt;0.01) was also significantly elevated in the thrombocytopenia group. Conclusion: HF patients with thrombocytopenia had worse clinical outcomes compared to those without. Very few studies have explored this impact of thrombocytopenia on HF and concluded with similar outcomes, probably related to abnormal platelet activity in this population and its consequence on cardiac function. This finding highlights the need for future studies to elucidate the pathophysiology and include platelet level in prognostic tools.
Abstract P388: Assessment of a Tailored Peer Mentoring Program Among Medicare Advantage Members With Hypertension
Authors: Micah Dasmariñas, An-Ting Jhuang, Samira Kamrudin, Samantha Heinrich, Brijesh Patel, Ashwin Patel, Jaime Murillo
Journal: Circulation (2023)

Introduction: Disparities in access to care coupled with chronic conditions that represent 70% of healthcare spending, highlight the importance of accessible support beyond in-person primary care. In this study, we assessed the feasibility of a virtual peer mentoring program, in which individuals who have successfully managed to live with hypertension serve as peer mentors to individuals with the same condition. We measured clinical improvement through possible blood pressure (BP) reductions as well as program engagement and satisfaction among study participants. Methods: The study consisted of 451 participants enrolled in a Medicare Advantage plan with hypertension and/or a recent systolic BP reading ≥140 mmHg. Participants were matched with a peer mentor and provided with virtual one-on-one engagement based on their hypertension management challenges. The program was defined as feasible if the average monthly engagement rate over the 6-month study period was at least 70%. A one-sample proportion test was used to determine feasibility and the Wilcoxon signed rank test assessed changes in BP between the first month and the sixth month after enrollment. Descriptive statistics were generated from the exit survey upon program completion. Results: The average monthly engagement rate was greater than 70% (p &lt; 0.001), indicating program feasibility. 116 individuals (25.7%) had a baseline systolic BP ≥ 140 mmHg, or diastolic BP ≥ 90 mmHg with both first and sixth month BP data. In this cohort, we found statistically significant median reductions in systolic BP &gt;5 mmHg (-7.5 mmHg; p=0.003) as well as diastolic BP (-3.9 mmHg; p&lt;0.001). The program received high satisfaction with a net promoter score of 79. Conclusion: This study showed a virtual peer mentoring program for individuals with hypertension is feasible. Both systolic and diastolic BP improved in the peer-matched group suggesting a beneficial intervention. In addition, the exit survey responses indicated satisfactory and positive experiences in this peer mentoring program.
Abstract P156: Use of Continuous Glucose Monitoring for Risk-Stratification in Older Adults With Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Michael Fang, Yein Jeon, Justin B Echouffo Tcheugui, Jung-Im Shin, Josef Coresh, Elizabeth Selvin
Journal: Circulation (2023)

Introduction: The American Diabetes Association (ADA) recommends individualizing treatment for older adults with diabetes based on their burden of comorbidities. However, implementing this recommendation in practice is challenging. Glucose excursions and variability may be markers of declining health that can identify high-risk older patients. Hypothesis: Glucose abnormalities are associated with comorbidities in older adults with diabetes. Methods: We conducted a cross-sectional analysis of 319 with type 2 diabetes (mean age 83 years) in the Atherosclerosis Risk in Communities Study (visit 9, 2021-2022). Participants wore continuous glucose monitoring (CGM) sensors for up to 14 days. We calculated four clinical measures from CGM data: mean glucose, standard deviation of glucose, % time with hypoglycemia (glucose &lt;54 mg/dl), and % time with hyperglycemia (glucose&gt;180 mg/dl). Based on ADA guidelines for older adults, we examined 6 comorbidities (defined using information from clinical examinations and medical records). We examined the association between CGM measures and comorbidities with logistic regression. Results: The prevalence of comorbidities ranged from 2% (dementia) to 66% (chronic kidney disease). Increased time with hypoglycemia was significantly associated with cardiovascular disease, chronic kidney disease, depression, and poor functional status (Table) . In contrast, comorbid conditions were not consistently related to mean glucose, standard deviation of glucose, or hyperglycemia. Conclusion: Hypoglycemia was common in those older adults with diabetes who had poor physical functioning and major comorbidities. CGM captures hypoglycemic episodes and may be a useful tool to supplement traditional risk assessment.
Abstract P391: Genetic Analysis of Blood Pressure Traits in African Populations
Authors: Ebuka I Onyenobi, Guanjie Chen, Ayo Doumatey, Ayotunde Famooto, Jie Zhou, Adebowale Adeyemo, Charles Rotimi, Clement Adebamowo, Sally Adebamowo
Journal: Circulation (2023)

High blood pressure is a heritable risk factor for cardiovascular disease, stroke and other chronic conditions. There is an increasing prevalence of high blood pressure in sub-Saharan Africa. We aimed to identify genetic variants underlying blood pressure traits in Sub-Saharan Africa. We conducted a GWAS, meta-analyses and gene-set analyses of blood pressure traits (systolic, diastolic, pulse pressure), in African populations. We used the African Collaborative Center for Microbiome and Genomics Research data (ACCME, n=~15,000) for GWAS discovery and the Africa America Diabetes Mellitus study data (AADM, n=~5,200), for GWAS replication. Multiple SNPs were identified reaching genome-wide significance. The lead SNP from the elevated blood pressure group was on chromosome 16 (rs148403740, minor allelic frequency (MAF)=0.0176, p= 9.28x10 -9 , odds ratio(OR)= 2.58) nearest to the MGRN1 gene. The lead SNP from the hypertension stage 1 group was on chromosome 7 (rs4236415, MAF= 0.4912, p= 1.33x10 -8 , OR= 1.2). The index SNP within the pulse pressure group was on chromosome 10 (rs61836106, MAF= 0.1828, p= 7.4x10 -9 , OR= 5.7). The findings provide promising candidate SNPs for developing risk stratification models in African populations.
Abstract P474: Sex-Specific Prevention of Stroke Through Reproductive Risk Factors and Sex Hormone Effects (STOP STROKE): Preliminary Findings
Authors: Tracy E Madsen, Sara L Caniglia, Juana Thomas, Lindsay Clark Donat, Ling Zhang, Ghada Bourjeily, Tina Burton, Karen L Furie, Simin Liu
Journal: Circulation (2023)

Background: There are known associations between sex-specific reproductive health factors such as reproductive lifespan and stroke risk. The relation of endogenous sex hormones, specifically sex hormone binding globulin (SHBG), to stroke risk remains uncertain, however, despite some data showing an inverse association between SHBG and stroke. We conducted a pilot case-control study to evaluate SHBG as a stroke risk factor, to report SHBG levels in the period immediately after acute ischemic stroke (AIS), and to demonstrate the feasibility of collecting data on sex hormones and reproductive history in this study population. Methods: In STOP STROKE, postmenopausal women were enrolled from a single large healthcare system in the northeast between July 2020 and May 2022. Case participants were postmenopausal women ≥50 years old newly admitted with AIS to a large stroke center; controls were postmenopausal women without a history of stroke recruited from an outpatient clinic in the same healthcare system. Among others, exclusion criteria included use of menopausal hormone therapy within 10 years, prior stroke, surgical menopause, and history of hormone-related cancers. We ascertained data on stroke risk factors and collected blood samples between 24 and 72 hours after stroke onset or at the time of enrollment for controls. Serum SHBG was measured using enzyme-linked immunosorbent assays. Following descriptive analyses, age- and BMI-adjusted SHBG levels were compared between cases and controls using multiple linear regression. Multiple logistic regression was then performed to assess associations between SHBG, clinical risk factors, and the outcome of AIS, with covariates chosen a priori based on prior literature. Results: In total, 32 cases and 30 controls were enrolled; median age was 69.0 years (IQR 64.5-82.0) for cases vs. 62.0 (IQR (59.0-68.0) for controls. The mean SHBG of AIS cases was 68.8 (SD 36.1) nmol/L compared to 56.6 (SD 30.0) nmol/L among controls (p=0.16). In models adjusted for age and body mass index (BMI), SHBG was similar between cases and controls (beta = 3.0, 95%CI -15.0 - 21.1, p=0.74). Adjusted for age, BMI, history of hypertension, history of diabetes, and age at menarche and menopause, there was a positive association between SHBG and AIS (OR 1.04, 95%CI 1.004-1.071, p=0.03). Conclusions: Our pilot study demonstrates the feasibility of enrolling newly admitted AIS patients and controls among postmenopausal women in the catchment area of our comprehensive stroke center. To understand initial findings of a positive association between SHBG and AIS, work is ongoing to measure estrogens and androgens at study baseline and all hormones in follow-up specimens (3-6 months post stroke).